Malignancy complicates one in a thousand pregnancies. The most frequently diagnosed of these are breast, cervical, melanoma, ovarian, and haematological neoplasms. Tumours of respiratory origin are very uncommon during pregnancy. We present a case of tracheal adenoid cystic carcinoma (ACC), a rare type of primary airway tumour, diagnosed in a pregnant woman. To our knowledge, this is the third reported case of tracheal ACC complicating pregnancy. We discuss potential barriers to timely diagnosis of malignancies during pregnancy and consider optimal management strategies, taking into account the potential harm to the mother and foetus in a field with a limited evidence base.

Background Asymptomatic postmenopausal women incidentally found to have thickened endometrium (>4 mm) on transvaginal ultrasound (TVUS) often undergo hysteroscopy and dilatation and curettage despite having a low absolute risk of endometrial cancer. A low threshold for investigation may be unnecessary in these women. Aim This systematic literature review examines whether an increased TVUS endometrial thickness threshold has superior diagnostic accuracy for endometrial malignancies and premalignancies in asymptomatic postmenopausal women than the current threshold of ≥4 mm. Methods Pubmed, EMBASE and Cochrane Database of Systematic Reviews were systematically searched using keywords for publications between 2011 and 2021. Studies were included if they reported TVUS endometrial thickness analysis in asymptomatic postmenopausal women and excluded if they were written in a non‐English language. Quality of evidence in the included articles was evaluated according to recommendations by the Grading of Recommendations Assessment Development and Evaluation Working Group and reported results were tabulated. Results Of seven studies (N = 2986), better evidence identified 12 mm as the optimal diagnostic threshold (area under the curve receiver operating characteristic (AUC ROC) 0.716, 95% CI 0.534–0.897, P = 0.019) for endometrial cancer in asymptomatic postmenopausal women. Two higher quality studies (n = 488 and n = 4751) identified 11 mm as optimal for diagnosing both endometrial carcinoma and atypical hyperplasia (AUC ROC 0.587, 95% CI 0.465–0.708, P = 0.144 and 2.59 relative risk, 95% CI 1.66–4.05, P < 0.001). Conclusion Evidence for improved detection of endometrial premalignancies and malignancies using alternative endometrial thickness thresholds is not rigorous. Evidence for improved outcomes using alternative thresholds is inadequate. Observation of asymptomatic postmenopausal women without risk factors and with an endometrial thickness of less than 10 mm may be reasonable.

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Study Objective To demonstrate, via robotic-assisted laparoscopy, a transperitoneal technique for repair of post-hysterectomy vesicovaginal fistula (VVF) using an omental interposition flap. Design Video article. Setting University Hospital and referral center for Gynaecological disease. Patients or Participants A 52-year-old woman with VVF after laparoscopic hysterectomy. Interventions Repair of post-hysterectomy VVF with omental flap interposition. Measurements and Main Results A 52-year-old woman with a history of menorrhagia refractory to medical treatment underwent a total laparoscopic hysterectomy and bilateral salpingectomy. Histology of the uterus showed multiple uterine fibroids and adenomyosis. Twelve days following the hysterectomy, she developed leakage of urine per vagina. Computed tomography scan and cystourethrogram demonstrated normal ureters and presence of a vesicovaginal fistula. An indwelling catheter was inserted to rest the bladder and allow the acute inflammation surrounding the fistula to subside prior to definitive surgical repair six weeks later. The repair consisted of seven steps: Restoration of anatomy Opening the vaginal vault Identification of fistula defect Resection of fistula tract Dissection of vesicovaginal space Closure of vesical and vaginal defects Interposition of omental graft The patient was discharged 48 hours after surgery. The indwelling catheter was maintained for 14 days. Cystourethrogram was carried out to confirm the integrity of the bladder prior to catheter removal. There was no further vaginal loss. Clinical follow up at six weeks and three months post-repair showed no bladder or vaginal dysfunction. Conclusion Robotic-assisted laparoscopy is a feasible approach for repair of VVF, which can be performed systematically using seven steps. This technology lends itself well to procedures requiring intricate dissection and multi-layered suturing as demonstrated in this case.